Introduction: Intramedullary headless cannulated compression screws (IHCCS) are becoming an increasingly common method of fixation for metacarpal and phalangeal fractures. Despite being relatively new, they are now becoming accepted as a safe and effective technique. Our literature review revealed that since 2015, 0/22 case series or cohort studies, and 1/6 systematic reviews have been published from Australia or New Zealand. We performed a retrospective cohort study of IHCCS for phalangeal and metacarpal fractures at our centre in Sydney, Australia. Methods: a search for all patients treated between 1st January 2021 and 30th August 2023 treated with cannulated compression screws (CCS) at our centre was performed, revealing 64 patients. 7 of these were excluded as the CCS used were either for fusion, scaphoid fractures, or other non-intramedullary techniques. Results: 57 patients (60 fractures: 35 metacarpal, 25 phalangeal) were included. Average follow-up time was 2.3 months. Range of motion documentation was highly variable, however 29 were recorded as having ‘full’ range, 8 patients had total active motion documented (mean = 212.5deg). Mean operative time was 37.4 minutes, complication rate was 5.3%, and grip strength of the injured hand reached 81.5% of the uninjured hand. Conclusion: Our single-centre cohort is one of the larger groups studied in recent years, and adds support to this method of fixation as safe, timely, and in line with centres around the world.